Chinese Journal of Blood Purification

12 July 2022, Volume 21 Issue 07 Previous Issue    Next Issue

Select

The effects of erythropoietin on renal fibrosis ZHANG Xiang, CHEN hong-bo 2022, 21 (07):  456-468.  doi: 10.3969/j.issn.1671-4091.2022.07.001 Abstract ( 220 )   PDF (361KB) ( 149 )   Renal fibrosis is a common end-stage pathological manifestation of chronic kidney disease (CKD), and its severity is closely related to the prognosis of CKD. In recent years, some studies have found that erythropoietin (EPO) is closely associated with the occurrence and development of renal fibrosis. As a regulator of red blood cell production, exogenous EPO supplementation can not only improve renal anemia, but also improve renal function and effectively prevent and treat renal fibrosis. Therefore, this paper reviews the role of EPO in renal fibrosis and its anti-fibrosis mechanism, providing new ideas for the application of EPO in the treatment of renal fibrosis in the future. Metrics

Select

Progress in the study of complications of renal anemia WANG Zeng, ZHANG Yang, WANG Qin, ZHU Qi- fan, CHEN Hong- yu 2022, 21 (07):  469-472.  doi: doi:10.3969/j.issn.1671-4091.2022.07.002 Abstract ( 72 )   PDF (400KB) ( 148 )   Renal anemia is one of the common symptoms of most patients with chronic kidney disease (CKD). Renal anemia will bring many complications, including cardiovascular disease, inflammatory state, and gastrointestinal bleeding, etc. In clinical correction of renal anemia, the treatment of complications should also be taken into account. This article reviews the literature on the mechanism and treatment of renal anemia complications for clinical reference. Metrics

Select

Establishment and validation of the Nomogram incorporating serum cystatin C for the technical survival of non-diabetic peritoneal dialysis patients 2022, 21 (07):  473-477.  doi: 10.3969/j.issn.1671-4091.2022.07.003 Abstract ( 170 )   PDF (464KB) ( 81 )   Objective To establish and verify a Nomogram incorporating serum cystatin C for the technical survival of non- diabetic peritoneal dialysis (PD) patients. Methods We included non- diabetic patients who newly admitted to PD treatment in our Hospital between January 2010 to January 2019. Demographic and biochemical data were collected. Urea clearance index and 4h dialysate to plasma creatinine ratio (4h D/PCr) were recorded 1 month after starting regular PD treatment. Episodes of peritonitis in the first year of PD were also recorded. Risk factors for end-point events were analyzed by Cox regression model. The Nomogram was used to evaluate the prediction of the 1,3 and 5-year technical survival rate of PD patients by meaningful indicators. The calibration curve and Harrell concordance index (C-index) were used to verify the accuracy of the Nomogram in predicting the technical survival rates of PD patients. Results We enrolled 163 patients, including 90 males (55.21%) and 73 females (44.78%), with an average age of (48.75±13.23) years. The serum cystatin C level was (5.56±1.08)mg/L. Univariate Cox regression showed that higher serum cys-tatin C (HR=1.275, 95% CI：1.031～1.577, P=0.026), male (HR=0.582, 95% CI：0.350～0.968, P=0.037), peritonitis episodes in the first year (HR=1.564, 95% CI：1.002～2.440, P=0.049), and higher 4h D/PCr (HR= 1.217, 95% CI：0.967～1.531, P=0.095) were risk factors for PD failure, while higher serum albumin (HR= 0.928, 95% CI：0.876～0.982, P=0.010), residual renal function (RRF), urea clearance index (Kt/V) (HR= 0.174, 95% CI：0.078～0.388, P＜0.001) and total Kt/V (HR=0.276, 95% CI：0.137～0.554, P＜0.001) were protective factors for PD technical survival. Because serum cystatin C had a collinearity with RRF Kt/V and total Kt/V, the Kt/V measurements were excluded. After incorporating the covariates with P ＜0.1 into a multivariate Cox regression, serum cystatin C was an independent risk factor for PD failure (HR=1.288, 95% CI： 1.032～1.603, P=0.025). The C-index of Nomogram predicting the technical survival rate of PD patients was 0.712(95% CI：0.652～0.772). The calibration curve also showed a good consistency between the prognostic Nomogram model and the actual observed values. Conclusion Technical survival was lower in non-diabetic PD patients with higher serum cystatin C levels before dialysis. The Nomogram incorporating serum cystatin C has a certain predictive value for the technical survival of PD patients Metrics

Select

Predictive value of bioelectrical impedance phase angle for hypoalbuminemia in maintenance hemodialysis patients  LIANG Wei- feng, LIU Yun, XU Shi- lin, CHEN Wen- xuan, TAN Rong- shao, LIU Yan, ZHONG Xiao- shi 2022, 21 (07):  478-482.  doi: doi:10.3969/j.issn.1671-4091.2022.07.004 Abstract ( 84 )   PDF (438KB) ( 69 )   Objective To evaluate the predictive value of bioelectrical impedance phase angle (PhA) for hypoalbuminemia in maintenance hemodialysis (MHD) patients. Methods This was a single-center and crosssectional study. A total of 136 patients who underwent MHD in our center in March 2021 were enrolled. Their basic information, biochemical indicators, dialysis-related indicators and pre-dialysis bioelectrical impedance measurement data were collected. The patients were divided into a hypoalbuminemia group (34 cases) and a non-hypoproteinemia group (102 cases). Clinical characteristics of the two groups were compared. Univariate and multivariate analysis were used to identify the related factors of hypoalbuminemia. The diagnostic value of PhA for hypoalbuminemia was analyzed using the receiver operating characteristic curve (ROC). Results Compared with the non- hypoalbuminemia group, the hypoalbuminemia group had lower PhA (Z=8.715, P<0.001). Spearman's analysis showed that PhA and serum albumin were positively correlated (r=0.609, P<0.001). Multivariate dichotomous logistic regression showed that lower PhA and serum calcium were the independent factors for hypoalbuminemia in MHD patients (OR=5.148, 95% CI: 2.550～10.394, P<0.001; OR=15.857, 95% CI: 1.302～193.170, P=0.030). ROC curve suggested that the optimal cut-off value of PhA for the diagnosis of hypoalbuminemia in MHD patients was 3.85° (AUC=0.815, 95% CI: 0.736～0.895, P＜0.001). Conclusion Lower PhA value is an independent influencing factor for hypoalbuminemia in MHD patients. Metrics

Select

Clinical efficacy of Roxadustat in the treatment of renal anemia in the initial hemodialysis patients 2022, 21 (07):  483-486.  doi: 10.3969/j.issn.1671-4091.2022.07.005 Abstract ( 257 )   PDF (433KB) ( 184 )   】Objective To explore the clinical efficacy and safety of Roxadustat in treatment of renal anemia in the initial hemodialysis patients. Methods A total of 90 patients with renal anemia at the initial hemodialysis stage and treated in Jiangxi Provincial Clinical Nephrology Research Center of Chinese Medicine - Jiujiang Hospital of Chinese Medicine in the period from November 2019 to January 2021 were enrolled in this study. They used Roxadustat for renal anemia for the first time. Roxadustat was continuously used for 12 weeks. Hemoglobin, erythrocyte count, serum iron, serum ferritin, transferrin saturation, albumin (ALB), C-reactive protein (CRP), triacylglycerol, total cholesterol, erythropoietin (EPO), hypoxia- inducible factor- 2α (HIF-2α), prolyl hydroxylase (PHD2) and von Hipper Lindau tumor suppressor protein (pVHL) were measured before and after the Roxadustat treatment. The adverse reactions of Roxadustat were also recorded. Results After the treatment for 12 weeks, the compliance rate of hemoglobin was 76.67%, serum iron increased (t=2.104, P=0.037), serum ferritin decreased (t=2.117, P=0.035), and transferrin saturation value remained stable; serum ALB, EPO and HIF2α increased (t=1.000, 29.071 and 10.709 respectively; P=0.318, 0.001 and 0.001 respectively), and CRP, PHD2 and pVHL decreased (t=7.904, 22.662 and 5.873 respectively; P=0.001), as compare with those before the treatment. Adverse reactions of Roxadustat therapy included hyperkalemia (3 cases), gastrointestinal symptoms (4 cases), infections (3 cases), chest tightness and discomfort (2 cases) and dizziness (one case); they all improved after symptomatic treatment. Conclusion Roxadustat can effec-tively improve renal anemia in patients at the initial hemodialysis stage, probably relating to its actions on regulating HIF2α/PHD2/EPO signaling pathway, improving iron metabolism, and inhibiting micro-inflammatory state in these patients.  Metrics

Select

Screening and risk factor analyses of abnormal left ventricular diastolic function in maintenance peritoneal dialysis patients ZHANG Qian-ying, XU Tian, LI Xiao, HUANG Xiao-min, ZHANG Chun-yan, REN Hong 2022, 21 (07):  487-491.  doi: 10.3969/j.issn.1671-4091.2022.07.006 Abstract ( 196 )   PDF (457KB) ( 79 )   Objectives To investigate the incidence and risk factors of abnormal left ventricular diastolic function in maintenance peritoneal dialysis (PD) patients with normal ejection fractions. Methods This study was a cross-sectional survey. Echocardiography data as well as clinical and laboratory data of the maintenance PD patients who came to Ruijin Hospital affiliated to Shanghai Jiao Tong University for follow-up between November 2020 and March 2021 were collected. PD patients with left ventricular ejection fraction ＞50% were enrolled for the screening study. Echocardiographic parameters, clinical and laboratory data were compared between patients with abnormal left ventricular diastolic function and control patients. Binary logistic regression was used to analyze the risk factors for abnormal left ventricular diastolic function in the PD patients with normal ejection fraction. Results A total of 103 patients were enrolled in the study. Abnormal left ventricular diastolic function (E/e’＞14) was found in 31 patients. In the PD patients with abnormal left ventricular diastolic function, fractional urea clearance (Kt/V) [median 2.0 (1.7, 2.3) vs. 2.1(1.9, 2.6), U=1406.000, P=0.037] and qualified blood pressure rate (29.0% vs. 51.4%, c2=4.382, P=0.036) were lower, and N-terminal pro b- type natriuretic peptide (NT- proBNP) [median 12131.0 (5242.0, 30883.0)pg/ml vs. 2981 (940.4, 14665.0)pg/ml, U=690.000, P=0.002], body weight (63.7±11.9kg vs. 58.2±10.2kg, t=2.390, P=0.019), body mass index (BMI) (23.9±3.5kg/m2 vs. 22.2±3.1kg/m2, t=2.484, P=0.015), body surface area (BSA) (1.7±0.2m2 vs. 1.6±0.2m2, t=2.051, P=0.043), and incidence of edema (67.7% vs. 30.6%, c2=12.322, P＜0.001) were higher, as compared with those in the control group (E/e’≤14). Logistic regression indicated that higher NT-proBNP (OR=5.790, 95% CI 1.724～19.440, P=0.004), increased BMI (OR=1.226, 95% CI 1.028～1.462, P=0.023) and edema (OR=3.827, 95% CI 1.190～12.310, P=0.024) were the independent risk factors for ab-normal left ventricular diastolic function in PD patients with normal eject fraction. Conclusion Edema, higher NT-proBNP and increased BMI are independently correlated with abnormal left ventricular diastolic function in maintenance PD patients with normal ejection fraction Metrics

Select

Association between blood trace elements and micro-inflammatory state in maintenance hemodialysis#br# patients LI Zi-yuan, LIU Yun, TAN Rong-shao, ZHONG Xiao-shi, LIU Yan 2022, 21 (07):  492-496.  doi: 10.3969/j.issn.1671-4091.2022.07.007 Abstract ( 149 )   PDF (496KB) ( 64 )   Objectives  To investigate the association between blood trace elements and micro-inflammatory state in maintenance hemodialysis (MHD) patients. Method This was a single-center and cross-sectional study. Patients undergoing MHD within September, 2019 in our center were enrolled in this study. Demographic, clinical data and blood samples were collected before hemodialysis session. Routine blood tests, serum biochemical parameters and blood trace elements were measured. According to hs-CRP level, patients were divided into micro-inflammatory state group (hs-CRP 3～15mg/L) and control group (hs-CRP＜3mg/L). Spearman analyses and binary logistic regression were performed to study the relationship between blood trace elements and micro- inflammatory state. Results A total of 128 MHD patients were enrolled in this study, including 65 patients in the micro-inflammatory state group and 63 patients in the control group. Spearman analyses showed that the levels of serum hs-CRP and IL-6 were positively correlated with the blood copper level (r=0.530 and 0.427, respectively; P＜0.001). Multivariate logistic regression showed that elevated level of blood copper and blood copper ≥810.60μg/L were independently associated with the micro-inflammatory state (OR=1.008, 95% CI: 1.004～1.012, P＜0.001; OR=7.406, 95% CI: 3.080～17.807, P＜0.001). Conclusion Elevated blood copper was independently associated with the micro-inflammatory state in MHD patients, indicating the necessity of blood copper monitoring in MHD patients. Metrics

Select

The influencing factor and prognostic value of pulmonary arterial hypertension in chronic kidney disease patients LI Wen, JIA Lin-pei, DONG Xing-tong, FU Wen-jing, LIN Na, ZHANG Ai-hua 2022, 21 (07):  497-501.  doi: 10.3969/j.issn.1671-4091.2022.07.008 Abstract ( 191 )   PDF (456KB) ( 73 )   Objective To observe the incidence, risk factors, and prognostic value of pulmonary arterial hypertension (PAH) in chronic kidney disease (CKD) patients at stage 1-5 and without dialysis. Methods A total of 570 CKD patients at stage 1-5 admitted to the Department of Nephrology, Xuanwu Hospital, Capital Medical University during the period from January1, 2018 to December 31, 2019 were recruited. They were divided into PAH group and non-PAH group. They were followed up until November 1, 2021, and the end event was all-cause mortality. Logistic regression was used to analyze the risk factors for PAH in the CKD patients, and Cox proportional hazards regression model was used to analyze the risk factors for death in these patients. Results The incidence of PAH in the CKD patients was 9.12% (52/570), including 22 patients with mild PAH (42.31%), 25 patients with moderate PAH (48.08%), and 5 patients with severe PAH (9.61%). Multivariate logistic regression showed that age (OR=1.036, 95% CI:1.008～1.063, P=0.010), complicated with chronic heart disease (OR=4.373, 95% CI:2.271～8.423, P＜0.001) and hemoglobin lower than 110g/L (OR= 2.218, 95% CI:1.024～4.801, P=0.043) were the risk factors for PAH in CKD patients. The 570 CKD patients were followed up for an average of 27.3 months, in which 67 cases (11.7%) died and 113 cases (19.8%) lost the follow-up. Kaplan-Meier survival analysis showed that the survival rate of the CKD patients in PAH group was significantly lower than those in non-PAH group (log-rank test: χ2=7.089, P=0.009). Multivariate Cox regression model showed that older age (HR=2.502, 95% CI:1.354～4.621, P=0.003) and anemia (HR=2.486, 95% CI:1.397～4.423, P=0.002) were the independent risk factors for all-cause death in CKD patients. Conclusions The incidence of PAH in CKD patients at stage 1-5 was 9.12%. Age, preexisted chronic cardiac disease and lower hemoglobin level were the risk factors for PAH. The survival rate of CKD patients in PAH group was significantly lower than those in non-PAH group. Older age and anemia were the independent risk factors for all-cause mortality in CKD patients. Metrics

Select

The correlation between serum osteosclerosis protein and osteopontin levels and vascular calcification in maintenance hemodialysis patients  ZHONG Jie, AN Chun-lan, ZHANG Jia-li 2022, 21 (07):  502-506.  doi: 10.3969/j.issn.1671-4091.2022.07.009 Abstract ( 170 )   PDF (530KB) ( 61 )   Objective To analyze the serum osteosclerosis protein (SOST) and osteopontin (OPN) levels and their correlation with vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 200 patients who received MHD and follow-up study in the Nephrology Departments of the three hospitals during June 2017 to September 2020 were recruited as the research subjects. Serum SOST and OPN were assayed before the first hemodialysis. The presence of vascular calcification during follow-up period was recorded. Their baseline data and serum SOST and OPN levels were compared, and the correlation between serum SOST and OPN levels and vascular calcification was evaluated. Results Among the 200 MHD patients, 64 cases had vascular calcification with the incidence of 32% (64/200). Serum phosphorus, calcium and OPN were higher while serum SOST was lower in the calcification group as compared with those in the noncalcification group (t=4.315, 5.556, 8.611 and 6.208 respectively, P<0.001). Multivariate logistic regression showed that serum phosphorus, calcium, SOST and OPN levels correlated with vascular calcification in the MHD patients (OR=8.590, 5.078, 0.489 and 1.062 respectively; 95% CI 2.752～26.815, 2.086～12.362, 0.352～0.680 and 1.039～1.085 respectively; P<0.001). ROC curve showed that the AUC values of serum SOST, OPN, and their combination in predicting vascular calcification were all >0.70; the decision curve showed that in the range of high- risk threshold of 0.16- 0.84, the prediction model using combined serum SOST and OPN levels was better than that using one of the serum levels in assessing the net benefit rate of vascular calcification in MHD patients. Conclusion Serum SOST and OPN levels were abnormal in MHD patients with vascular calcification. They were closely related to vascular calcification. Metrics

Select

Multicentre Analysis of Clinical Characteristics in Maintenance Hemodialysis Patients with Inadequate Dialysis JIANG Zhen-bin, GAN Liang-ying, LI Zhong-xin, SHEN Yu-lan, ZHAO Xiao-lin, MA Ying-chun, YU Yongwu, QI Gui-jing, LI Wei-hua, XU Ming-cheng, ZHANG Dong-liang, ZUO Li, WANG Mei 2022, 21 (07):  507-511,540.  doi: 10.3969/j.issn.1671-4091.2022.07.010 Abstract ( 223 )   PDF (499KB) ( 169 )   Objective The purpose of this study was to investigate the clinical characteristics of inadequate dialysis in hemodialysis patients, so as to provide the evidences for improving clinical diagnosis and treatment of inadequate dialysis and promoting dialysis adequacy. Methods This study was a multi- center and cross-sectional survey. We retrospectively analyzed the patients with the single pool Kt/V (spKt/V) <1.2 in a measurement during January to March 2018 from 12 centers. Their demographic, treatment prescription, actual treatment and residual renal function data were collected and analyzed. SPSS 22.0 statistical software was used for data analysis, and Spearman correlation analysis was used to test the correlation between body weight after dialysis, blood flow rate (BFR), and weight-normalized BFR. Results A total of 224 patients were enrolled in this study. Their average age was 58.2±13.3 years, and the male to female ratio was 5.2:1. The prescribed spKt/V was 1.39±0.29, and the measured spKt/V was 1.06±0.11. In the 117 (52.2%) patients whose prescribed Kt/V was <1.4, the KoA of dialyzer (t=-8.619, P<0.001), BFR (t=-3.846, P＜0.001) and weight-normalized BFR (t=-12.577, P＜0.001) were significantly lower than those in spKt/V ≥1.4 group. In the 224 patients, weight-normalized BFR decreased gradually with the increase of body weight (ρ=-0.666, P< 0.001). There were 42 patients (18.8%) whose dialysis time was less than 240min, and 35 patients (15.6%) with blood coagulation in dialyzer. Residual native kidney function was present in 87 patients (38.84%); 14 of the 87 patients were tested for residual renal function, of which 5 patients fulfilled the standard Kt/V after combination of the Kt/V values from residual renal function and dialysis. Conclusion Insufficient dialysis in hemodialysis patients may relate to the lower prescribed Kt/V, lower weight-normalized BFR, shorter dialysis time, blood coagulation in dialyzer, unreasonable calculation methods for dialysis adequacy, and acute complications during hemodialysis sessions. Metrics

Select

Characteristics of thyroid function and the relationship with cardiac structure and function in maintenance hemodialysis patients  WU Di, LIU Hong-chao, WANG Guang-pu, SUN Jing-hua, JIANG Gan-ru, YIN Zhong-cheng 2022, 21 (07):  512-516.  doi: 10.3969/j.issn.1671-4091.2022.07.011 Abstract ( 128 )   PDF (451KB) ( 76 )   Objective To analyze the characteristics of thyroid function and the relationship with cardiac structure and function in maintenance hemodialysis (MHD) patients. Methods A total of 83 patients on regular hemodialysis for more than 3 months at The Affiliated Hospital of Xuzhou Medical University during the period from January 2019 to December 2020 were enrolled in this study. Thyroid function characteristics of the patients and the relationship with heart structure and function were analyzed. Results Thyroid dysfunction was found in 30 (36.1%) cases, of which most had a decrease of FT3 (10.8%) and an increase of TSH (13.3% ). Compared with the thyroid normal group, HDL (t=2.594 P=0.011) was lower, and serum LDL (t=2.520 P=0.015), triglycerides (Z=2.796, P=0.005) and C-reactive protein (CRP) (Z=2.067, P=0.009) were higher in the thyroid dysfunction group; in addition, the left atrium diameter (t=2.373, P=0.020), left ventricular diastolic end diameter (t=2.390 P=0.021), left ventricular posterior diastolic wall thickness (t=2.561, P=0.014), interventricular septal thickness (t=2.688, P=0.010) and left ventricular mass index (t=3.785, P＜0.001) were higher, and the left ventricular ejection fraction (t=3.721, P＜0.001) was lower in the thyroid dysfunction group. Patients with left ventricular hypertrophy had older age (t=2.159, P=0.034), longer dialysis age (Z=2.769, P=0.006), higher levels of CRP (Z=4.196, P＜0.001), LDL (t=3.059, P=0.003), parathyroid hormone (PTH) (Z=2.139, P=0.032) and TSH (Z=2.827, P=0.005), but lower levels of hemoglobin (t=2.616, P=0.011), pre- albumin (t=2.515, P=0.014), albumin (t=2.643, P=0.010), FT3 (t=4.581, P＜0.001) and FT4 (t=3.693, P＜0.001), as compared with those in the patients without left ventricular hypertrophy. Binary logistic analysis showed that hemoglobin (B=0.034, OR=0.967, 95% CI 0.939～0.995, P=0.022), FT3 (B=1.195, OR=0.303, 95% CI 0.128～0.713, P=0.006) and FT4 (B=0.427, OR=0.653, 95% CI 0.487～0.875, P=0.004) were the protective factor for patients to have normal left ventricular thickness. Conclusion Lower FT3 and higher TSH are common in MHD patients, and are the risk factors for left ventricular hypertrophy in MHD patients. Metrics

Select

Research progress in the dialysis therapy for end- stage renal disease women with pregnancy WANG Ying-ying, ZHANG Wen-jun 2022, 21 (07):  517-520.  doi: 10.3969/j.issn.1671-4091.2022.07.012 Abstract ( 148 )   PDF (377KB) ( 94 )   The number of end-stage renal disease (ESRD) patients treated with dialysis is gradually increasing in China. Female ESRD patients at childbearing age are facing reproduction problems with a higher risk during pregnancy. The cases of successful pregnancy and delivery in ESRD women increased recently due to the advances in dialysis technology. This article introduces the research progress in the dialysis therapy for ESRD women with pregnancy. Metrics

Select

Research progress in the relationship between uremic toxins and sarcopenia in chronic kidney disease patients FANG Lv- gui, XUAN Ming- yang, DU Ya- ting, RAO Xiang- rong 2022, 21 (07):  521-524.  doi: 10.3969/j.issn.1671-4091.2022.07.013 Abstract ( 140 )   PDF (378KB) ( 154 )   Sarcopenia in chronic kidney disease patients is caused by many factors, of which one is the uremic toxins, which distinguishes CKD sarcopenia from other sarcopenias. We have reviewed and analyzed the literature about the effect of uremic toxins on sarcopenia in order to comprehend the pathogenesis of sarcopenia and to find out the references for the treatment strategies of sarcopenia in CKD patients. Here we summarized the recent progresses in the relationship between uremic toxins and CKD sarcopenia, in an attempt to explore a meaningful research subject and a novel strategy for the treatment of CKD sarcopenia by removal of uremic toxins. Metrics

Select

Renin-angiotensin-aldosterone inhibitor and hyperkalemia in patients with maintenance hemodialysis HE Shi- ting, XIE Wei- ji, ZHANG Yi- min 2022, 21 (07):  525-529.  doi: 10.3969/j.issn.1671-4091.2022.07.014 Abstract ( 238 )   PDF (424KB) ( 246 )   Renin-angiotensin-aldosterone inhibitor (RASi) plays an important role in lowering blood pressure and maintaining cardiac and renal function, but it also blocks the secretion of aldosterone and causes hyperkalemia. Given that RASi may lead to elevated serum creatinine and hyperkalemia in patients with chronic kidney disease (CKD) whose glomerular filtration rate has decreased, there are concerns about the use of such drugs in patients with nondialysis stage CKD 4-5. For people on maintenance hemodialysis (MHD), the safety of RASi is controversial due to the presence of factors (such as diet, clearance, medication, etc.) that affect the blood potassium of patients with MHD and the possible interaction between many factors. Metrics

Select

AThe influencing factors of arteriovenous fistula dysfunction in non-diabetic maintenance hemodialysis patients WU Ling-yu, FAN Pei-qi, GUO Gang-ling, LI Jing, WANG Li-hua 2022, 21 (07):  530-535.  doi: 10.3969/j.issn.1671-4091.2022.07.015 Abstract ( 233 )   PDF (475KB) ( 248 )   Objective To investigate the failure of arteriovenous fistula (AVF) in non-diabetic hemodialysis patients and to explore the related factors affecting the AVF function. Methods Ninety-two non-diabetic patients who received maintenance hemodialysis (MHD) in the Hemodialysis Center of The Second Hospital of Shanxi Medical University from January to June 2021 and had complete clinical data were enrolled in this study. The patients were divided into AVF normal group and AVF failure group according to the diagnosis criteria of AVF failure. The differences in clinical data were retrospectively analyzed between the two groups. Multivariate Cox risk regression model was used to analyze the influencing factors Results Diastolic blood pressure (t=-5.143, P< 0.001), cephalic vein diameter (Z=-3.847, P< 0.001), radial artery diameter (Z=-3.734, P<0.001), and serum albumin (t=-3.741, P=0.001) were lower, while serum phosphorus (t=2.076, P=0.041), calcium-phosphorus product (t=2.444, P=0.016), C-reactive protein (Z=2.477, P=0.013) and the incidence of malnutrition-inflammation-atherosclerosis syndrome (MIAS) (χ2=4.943, P=0.026) were higher in AVF failure group as compared those in AVF normal group. Multivariate Cox regression showed that higher diastolic blood pressure (HR=0.957, 95% CI：0.917～0.998, P=0.039), higher serum albumin (HR=0.831, 95% CI： 0.767～0.899, P<0.001), and larger radial artery diameter (HR=0.079, 95% CI 0.019～0.338, P=0.001) were the protective factors for functional AVF, while the complication of MIAS (HR=4.059, 95% CI 1.128～ 14.614, P=0.032) was a risk factor for AVF failure. Kaplan-Meier survival curve showed that the AVF lifetime in patients with hypoalbuminemia was significantly shorter than that in patients without hypoalbuminemia (log-rank test: c2=27.776, P<0.001). Conclusion Higher diastolic blood pressure is a protective factor for functional AVF, while hypoalbuminemia and the complication of MIAS are risk factors for AVF failure in nondiabetic MHD patients. Metrics

Select

Effect of geriatric nutritional risk index (GNRI)-based stratified diet intervention on nutritional status  and self- efficacy in elderly patients with maintenance hemodialysis  WANG Ying, WU Juan- juan, XU Fang-fang, SHEN Xia, YE Hong 2022, 21 (07):  536-540.  doi: 10.3969/j.issn.1671-4091.2022.07.016 Abstract ( 173 )   PDF (439KB) ( 107 )   Objective To explore the effect of stratified dietary intervention based on geriatric nutritional risk index (GNRI) on nutritional status and self-efficacy in elderly patients with continuous hemodialysis (MHD). Methods A total of 60 elderly MHD patients treated in The Second Affiliated Hospital of Nanjing Medical University from January 2020 to January 2021 were randomly selected and divided into an intervention group (n=30) and a control group (n=30) by random number table method. The control group implemented conventional intervention measures, and the intervention group implemented GNRI stratified dietary intervention in addition to the conventional intervention measures. The changes of nutritional status after 3 months of the interventions, including the score of subjective global assessment (scored patient-generated subjective global assessment, PG-SGA score), body mass index (body mass index, BMI), triceps skin triceps skin fold (TSF), self- efficacy (general self- efficacy scale score, GSES score), dietary treatment attitude (the attitude scale for the dietary therapy of hemodialysis patients, ASDTH score), and quality of life (kidney disease quality of life short form score, KDQ score) were compared between the two groups. Results After 3 months of the interventions, PG-SGA score, BMI, TSF, event coping, goal achievement and individual problem solving, ASDTH score and KDQ score were higher in the intervention group than in the control group (t=5.450, - 2.199, - 3.510, - 5.122, - 5.142, - 5.085, - 4.280 and - 4.959, respectively; P<0.001, =0.032, =0.001, <0.001, <0.001, =0.001, <0.001 and <0.001, respectively). Conclusion GNRI stratified dietary intervention can improve the nutritional status, self- efficacy, diet therapy attitude and quality of life in elderly MHD patients, highlighting its value in clinical application. Metrics

Select

TR-350 immunoadsorption used in the neuromyelitis optica spectrum disorders: its clinical effects and#br# nursing methods XIONG Yun- jin, ZHOU Ran, GU Jing, GONG Yong, ZHANG Yin, ZHOU Yi- lun 2022, 21 (07):  541-544.  doi: 10.3969/j.issn.1671-4091.2022.07.017 Abstract ( 270 )   PDF (407KB) ( 61 )   Objective To summarize the clinical effects and nursing methods of TR-350 immunoadsorption in treatment of the national rare disease, the neuromyelitis optica spectrum disorders. Methods General situation of the patients, abnormal reactions during treatment, equipment alarm, management and clinical results were collected. Results Visual acuity and nerve function improved significantly after the immunoadsorption treatment. The extended disability status scale (EDSS) reduced from (5.84 ± 2.16) to (4.46 ± 2.13) (t=5.404, P=0.005). The concentration of anti- aquaporin- 4 autoantibody also decreased significantly from (72.14±24.21)μ/ml to (16.72±6.63)μ/ml (t =10.793, P＜0.001). In the 68 cases during treatment, hypotension occurred in one case, catarrh symptoms in 5 cases, equipment alarm in 14 cases, and unplanned termination of the treatment in one case. Conclusions The immunoadsorption effect is obvious but the operation is complicated. Therefore, the operation nurses are required to strictly follow the operation processes, and have the abilities to analyze the cause of equipment alarm and to manage the emergencies to ensure success of the treatment. Metrics